• Amygdala
• Molecular mechanism
• Oxidative stress
• PI3K/Akt pathway
• Precision medicine
• Stress response

• Humans
• Stress, Psychological/metabolism
• Stress, Psychological/physiopathology
• Animals
• Hypothalamo-Hypophyseal System/metabolism
• Adaptation, Physiological/physiology
• Pituitary-Adrenal System/metabolism

• Blood Glucose
• Glycemic Control
• Intensive Care Units
• Prognosis
• Traumatic Brain Injury

• Humans
• Brain Injuries, Traumatic/blood
• Brain Injuries, Traumatic/mortality
• Brain Injuries, Traumatic/complications
• Male
• Female
• Middle Aged
• Retrospective Studies
• Prognosis
• Blood Glucose/analysis
• Blood Glucose/metabolism
• Adult
• Aged
• Hospital Mortality
• Glasgow Coma Scale
• Intensive Care Units/statistics & numerical data
• Databases, Factual
• Hyperglycemia/blood
• Hyperglycemia/mortality

• diabetes mellitus
• euglycaemic ketoacidosis
• metabolic acidosis
• side-effects
• sodium-glucose cotransporter-2 inhibitor

• Humans
• Sodium-Glucose Transporter 2 Inhibitors/adverse effects
• Diabetes Mellitus, Type 2/complications
• Diabetes Mellitus, Type 2/drug therapy
• Ketosis
• Glucose
• Sodium

• All-cause mortality
• Intensive care unit
• MIMIC-IV database
• Triglyceride-glucose index

• Humans
• Length of Stay
• Critical Illness
• Retrospective Studies
• Glucose
• Triglycerides
• Blood Glucose
• Risk Factors
• Biomarkers

• National Natural Science Foundation of China
• Jiangsu Elderly Health Research Project
• Top-level Clinical Discipline Project of Shanghai Pudong

• acute kidney injury
• cardiac surgery
• cardiopulmonary bypass
• perioperative risk stratification
• renal replacement therapy

• Clinical trial
• Enteral formula
• ICU
• Mechanical ventilation
• Wheat germ

Recent clinical trials confirmed the corticosteroid dexamethasone as an effective treatment for patients with COVID-19 requiring mechanical ventilation. However, limited attention has been given to potential adverse effects of corticosteroid therapy. The objective of this study was to determine the association between corticosteroid administration and impaired glycemic control among COVID-19 patients requiring mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation.

Multicenter retrospective cohort study between March 9 and May 17, 2020. The primary outcome was days spent with at least 1 episode of blood glucose either >180 mg/dL or <80 mg/dL within the first 28 days of admission.

Twelve hospitals in a United States health system.

Adults diagnosed with COVID-19 requiring invasive mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation.

None.

We included 292 mechanically ventilated patients. We fitted a quantile regression model to assess the association between steroid administration ≥320 mg methylprednisolone (equivalent to 60 mg dexamethasone) and impaired glycemic control. Sixty-six patients (22.6%) died within 28 days of intensive care unit admission. Seventy-one patients (24.3%) received a cumulative dose of least 320 mg methylprednisolone equivalents. After adjustment for gender, history of diabetes mellitus, chronic liver disease, sequential organ failure assessment score on intensive care unit day 1, and length of stay, administration of ≥320 mg methylprednisolone equivalent was associated with 4 additional days spent with glucose either <80 mg/dL or >180 mg/dL (B = 4.00, 95% CI = 2.15-5.85, P < .001).

In this cohort study of 292 mechanically ventilated COVID-19 patients, we found an association between corticosteroid administration and higher incidence of both hyperglycemia and hypoglycemia.

• COVID-19
• corticosteroids
• dexamethasone
• glycemic control
• hyperglycemia
• hypoglycemia
• mechanical ventilation

• critical illness
• gluconeogenesis
• glucose
• glycogenolysis
• hormones
• hyperglycemia
• hypoglycemia
• inflammation
• insulin

• Blood Glucose/metabolism
• Critical Illness
• Gluconeogenesis
• Glucose
• Humans
• Hypoglycemia/etiology
• Insulin
• Liver/metabolism

• K23 GM122069 NIGMS NIH HHS

• Administration, Oral
• Biguanides/administration & dosage
• Blood Glucose/drug effects
• Blood Glucose/metabolism
• Diabetes Mellitus, Type 2/blood
• Diabetes Mellitus, Type 2/drug therapy
• Diabetes Mellitus, Type 2/surgery
• Dipeptidyl-Peptidase IV Inhibitors/administration & dosage
• Humans
• Hypoglycemic Agents/administration & dosage
• Perioperative Care/methods
• Perioperative Care/trends

• Critically ill
• Glucose
• Insulin
• Insulin resistance
• Postoperative care
• Stress hyperglycemia

• Blood Glucose
• Critical Illness
• Diabetes Mellitus, Type 2/drug therapy
• Humans
• Hyperglycemia/drug therapy
• Hypoglycemia/drug therapy
• Hypoglycemic Agents/therapeutic use
• Inpatients
• Insulin
• Prospective Studies

• Acute gastrointestinal injury
• Enteral nutrition
• Gut rest strategy
• Trophic feeding

We assessed the association of intravenous insulin and glucose infusion with intensive care unit (ICU) and hospital mortality.

For this retrospective association study, we used data from all patients admitted to a medical-surgical ICU between January 2012 and September 2017. We excluded patients admitted < 24 h, patients with a diabetic ketoacidosis, patients with a therapy restriction upon ICU admission and readmissions. Using multivariate logistic regression, we examined the relation between intravenous insulin and glucose infusion and ICU and hospital mortality for all patients. Additionally, we used the same model to analyze the outcomes for patients admitted > 72 h.

Of 9507 eligible patients, 3966 were included. After correction for potential confounders, intravenous insulin was associated with ICU and hospital mortality in patients admitted > 24 h (n = 3966) (odds ratio (OR) 1.09 [95% CI 1.05–1.13] and 1.09 [95% CI 1.06–1.13] per 0.1 IU/kg added, respectively). Likewise, intravenous glucose was associated with ICU mortality (OR 1.01 [95% CI 1.00–1.01]) but not with hospital mortality and (OR 1.00 [95% CI 1.00–1.01]) per g/day added, respectively. In patients admitted > 72 h (n = 1550), insulin dose was associated with both ICU and hospital mortality (p = 0.002 and p < 0.001, respectively), but glucose infusion was not (p = 0.08 and p = 0.2, respectively).

Intravenous insulin administration is associated with an increased risk of ICU and hospital mortality, after correction for potential confounders. Parenteral glucose administration was limited in amount but was still associated with ICU mortality. However, based on these results, it is unknown whether this association is an epiphenomenon, or represents a true harm of insulin and glucose administration.

The online version of this article (10.1186/s13613-019-0507-x) contains supplementary material, which is available to authorized users.

• Critical illness
• Glucose
• Glycemic control
• Hyperglycemia
• Insulin
• Intensive care unit
• Mortality

• Diabetes mellitus
• Dysglycemia
• Glucose monitoring
• Hyperglycemia
• Hypoglycemia
• Insulin therapy
• Metabolic stress
• Stress hyperglycemia

• Glycaemic variability
• Hyperglycaemia
• Hypoglycaemia
• Insulin resistance
• Surgical stress

• Blood Glucose/analysis
• Diabetes Mellitus/blood
• Diabetes Mellitus/therapy
• Diabetes Mellitus, Type 2/blood
• Diabetes Mellitus, Type 2/drug therapy
• Humans
• Hypoglycemic Agents/administration & dosage
• Hypoglycemic Agents/therapeutic use
• Insulin/administration & dosage
• Insulin/therapeutic use
• Perioperative Care

• Diabetes
• Glycaemic control
• Insulin pump
• Insulin resistance
• Insulin therapy
• Perioperative

Intravenous (IV) fluids are an integral part of perioperative management. Intraoperative hyperglycemia is associated with poor clinical outcomes in patients undergoing major surgeries even in nondiabetics.

This study was conducted to observe the effect of different maintenance fluid regimens on intraoperative blood glucose levels in nondiabetic patients undergoing major surgeries under general anesthesia.

Randomized double-blind study.

One hundred nondiabetic patients of either sex were divided randomly into two Groups I and II of 50 each undergoing elective major surgeries of more than 90 min duration under general anesthesia. Both groups were given calculated dosage of IV fluids accordingly 4-2-1 formula while Group I was given Ringer lactate (RL) and Group II was given 0.45% dextrose normal saline and potassium chloride 20 mmol/L. Changes in vital parameters, % oxygen saturation, and urine output were monitored at regular intervals. Capillary blood glucose (CBG) was measured half-hourly until end of surgery. If CBG level was more than 150 mg%, then calculated dose of human insulin (CBG/100) was given as IV bolus dose.

Statistical analysis was done using SPSS 22.0 software (IBM Corporation, Armonk, New York, USA), paired t-test and Chi-square test.

A significant increase of CBG level and was observed during intraoperative and immediate postoperative period (P < 0.001) in Group II.

RL solution is probably the alternative choice of IV fluid for perioperative maintenance and can be used as replacement fluid in nondiabetic patients undergoing major surgeries.

• Double-blind method
• Ringer's lactate
• human
• hyperglycemia
• insulin
• regular

Glycemic control among critically-ill patients has been a topic of considerable attention for the past 15 years. An initial focus on the potentially deleterious effects of hyperglycemia led to a series of investigations regarding intensive insulin therapy strategies that targeted tight glycemic control. As knowledge accumulated, the pursuit of tight glycemic control among critically-ill patients came to be seen as counterproductive, and moderate glycemic control came to dominate as the standard practice in intensive care units. In recent years, there has been increased focus on the importance of hypoglycemic episodes, glycemic variability, and premorbid diabetic status as factors that contribute to outcomes among critically-ill patients. This review provides a survey of key studies on glucose control in critical care, and aims to deliver perspective regarding glycemic management among critically-ill patients.

• Glycemic control
• Critical care
• Blood sugar in intensive care unit
• Diabetes in intensive care unit
• Glycemic control

• Critically ill
• blood glucose
• continuous glucose monitoring (CGM)
• diabetes of injury
• insulin
• stress hyperglycaemia
• stress response

• Intravenous Blood Glucose (IVBG) system
• accuracy
• critical care glucose monitoring
• glucose sensor
• near-continuous glucose monitoring system
• safety

• Adult
• Aged
• Automation
• Blood Glucose/analysis
• Calibration
• Catheterization
• Equipment Design
• Female
• Hospitalization
• Humans
• Infusion Pumps, Implantable
• Infusions, Intravenous/instrumentation
• Infusions, Intravenous/methods
• Insulin Infusion Systems
• Male
• Middle Aged
• Monitoring, Physiologic/instrumentation
• Monitoring, Physiologic/methods
• Patient Safety
• Prospective Studies
• Reproducibility of Results
• United States

In a randomized controlled trial comparing tight glucose control with a computerized decision support system and conventional protocols (post hoc analysis), we tested the hypothesis that hypoglycemia is associated with a poor outcome, even when controlling for initial severity.

We looked for moderate (2.2 to 3.3 mmol/L) and severe (<2.2 mmol/L) hypoglycemia, multiple hypoglycemic events (n ≥3) and the other main components of glycemic control (mean blood glucose level and blood glucose coefficient of variation (CV)). The primary endpoint was 90-day mortality. We used both a multivariable analysis taking into account only variables observed at admission and a multivariable matching process (greedy matching algorithm; caliper width of 10⁻⁵ digit with no replacement).

A total of 2,601 patients were analyzed and divided into three groups: no hypoglycemia (n =1,474), moderate hypoglycemia (n =874, 34%) and severe hypoglycemia (n =253, 10%). Patients with moderate or severe hypoglycemia had a poorer prognosis, as shown by a higher mortality rate (36% and 54%, respectively, vs. 28%) and decreased number of treatment-free days. In the multivariable analysis, severe (odds ratio (OR), 1.50; 95% CI, 1.36 to 1.56; P =0.043) and multiple hypoglycemic events (OR, 1.76, 95% CI, 1.31 to 3.37; P <0.001) were significantly associated with mortality, whereas blood glucose CV was not. Using multivariable matching, patients with severe (53% vs. 35%; P <0.001), moderate (33% vs. 27%; P =0.029) and multiple hypoglycemic events (46% vs. 32%, P <0.001) had a higher 90-day mortality.

In a large cohort of ICU patients, severe hypoglycemia and multiple hypoglycemic events were associated with increased 90-day mortality.

Clinicaltrials.gov Identifier: NCT01002482. Registered 26 October 2009.

• Critical care
• Hyperglycemia
• Hypoglycemia
• Insulin infusion therapy
• Regular insulin
• Short acting insulin

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Blood Glucose/analysis
• Critical Care
• Cross-Over Studies
• Female
• Humans
• Hyperglycemia/drug therapy
• Hypoglycemic Agents/administration & dosage
• Insulin/administration & dosage
• Insulin Lispro/administration & dosage
• Insulin, Regular, Human/administration & dosage
• Intensive Care Units
• Male
• Middle Aged
• Prospective Studies
• Single-Blind Method
• Young Adult

Blood glucose control in intensive care unit (ICU) patients, addressed to actively maintain blood glucose concentration within defined thresholds, is based on two major therapeutic interventions: to supply an adequate calories load and, when necessary, to continuously infuse insulin titrated to patients needs: intensive insulin therapy (IIT). Short acting insulin analogues (SAIA) have been synthesized to improve the chronic treatment of patients with diabetes but, because of the pharmacokinetic characteristics that include shorter on-set and off-set, they can be effectively used also in ICU patients and have the potential to be associated with a more limited risk of inducing episodes of iatrogenic hypoglycemia. Medical therapies carry an intrinsic risk for collateral effects; this can be more harmful in patients with unstable clinical conditions like ICU patients. To minimize these risks, the use of short acting drugs in ICU patients have gained a progressively larger room in ICU and now pharmaceutical companies and researchers design drugs dedicated to this subset of medical practice. In this article we report the rationale of using short acting drugs in ICU patients (i.e., sedation and treatment of arterial hypertension) and we also describe SAIA and their therapeutic use in ICU with the potential to minimize iatrogenic hypoglycemia related to IIT. The pharmacodynamic and pharmachokinetic characteristics of SAIA will be also discussed.

• Insulin analogues
• Short acting drugs
• Intensive insulin therapy
• Glycemia management
• Intensive care

• Blood Glucose/analysis
• Critical Care/methods
• Drug Therapy, Computer-Assisted
• Female
• Humans
• Hypoglycemic Agents/therapeutic use
• Insulin/therapeutic use
• Intensive Care Units
• Male
• Middle Aged

• Blood Glucose/drug effects
• Blood Glucose/metabolism
• Cardiac Surgical Procedures/adverse effects
• Child, Preschool
• Cross-Over Studies
• Female
• Glucose/administration & dosage
• Humans
• Hyperglycemia/blood
• Hyperglycemia/etiology
• Hyperglycemia/prevention & control
• Infant
• Infusions, Intravenous
• Male
• Postoperative Complications/blood
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Time Factors

Acute kidney injury (AKI) is a serious complication in the perioperative period, and is consistently associated with increased rates of mortality and morbidity. Two major consensus definitions have been developed in the last decade that allow for easier comparison of trial evidence. Risk factors have been identified in both cardiac and general surgery and there is an evolving role for novel biomarkers. Despite this, there has been no real change in outcomes and the mainstay of treatment remains preventive with no clear evidence supporting any therapeutic intervention as yet. This review focuses on definition, risk factors, the emerging role of biomarkers and subsequent management of AKI in the perioperative period, taking into account new and emerging strategies.

• Acute kidney injury
• Biomarkers
• Perioperative
• Pharmacological interventions
• Risk stratification

Hyperglycemia is common in critically ill patients and can be caused by various mechanisms, including nutrition, medications, and insufficient insulin. In the past, hyperglycemia was thought to be an adaptive response to stress, but hyperglycemia is no longer considered a benign condition in patients with critical illnesses. Indeed, hyperglycemia can increase morbidity and mortality in critically ill patients. Correction of hyperglycemia may improve clinical outcomes. To date, a definite answer with regard to glucose management in general intensive care unit patients, including treatment thresholds and glucose target is undetermined. Meta-analyses of randomized controlled trials suggested no survival benefit of tight glycemic control and a significantly increased incidence of hypoglycemia. Studies have shown a J- or U-shaped relationship between average glucose values and mortality; maintaining glucose levels between 100 and 150 mg/dL was likely to be associated with the lowest mortality rates. Recent studies have shown glycemic control < 180 mg/dL is not inferior to near-normal glycemia in critically ill patients and is clearly safer. Glycemic variability is also an important aspect of glucose management in the critically ill patients. Higher glycemic variability may increase the mortality rate, even in patients with the same mean glucose level. Decreasing glucose variability is an important issue for glycemic control in critically ill patients. Continuous measurements with automatic closed-loop systems could be considered to ensure that blood glucose levels are controlled within a specific range and with minimal variability.

• Critical care
• Glycemic control
• Hyperglycemia
• Hypoglycemia
• Insulin

• critically ill
• glucose control
• glycemic variability
• hypoglycemia
• insulin
• intensive care unit
• nursing workload
• stress hyperglycemia